eMedicine Specialties > Dermatology > Bacterial Infections

Lymphogranuloma Venereum: Treatment & Medication

Author: Jose Antonio Plaza, MD, Director of Dermatopathology, Department of Pathology, Froedtert Hospital; Assistant Professor, Department of Pathology, Section of Dermatopathology, Medical College of Wisconsin
Coauthor(s): Victor G Prieto, MD, PhD, Director of Dermatopathology, Professor, Departments of Pathology and Dermatology, University of Texas MD Anderson Cancer Center
Contributor Information and Disclosures

Updated: Sep 2, 2009

Treatment

Medical Care

The treatment of choice for lymphogranuloma venereum (LGV) is doxycycline (100 mg orally bid for 21 d). Although azithromycin is effective against other chlamydial strains and may prove to be effective against infection with LGV serovars, no controlled treatment trials support the use of azithromycin treatment for LGV. Incision and drainage may result in nonhealing fistula formation, which can be minimized by draining involved lymph nodes from above the inguinal ligament. Symptomatic treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and local heat for pain relief may be useful adjuncts.

Immunocompromised persons, such as those with HIV infection, should receive the same treatment as immunocompetent persons; however, given the lack of data, patients with HIV infection and other immunocompromising conditions should be followed closely to assess resolution of symptoms.9

The New York State Department of Health clinical guideline summary, Lymphogranuloma Venereum (LGV), may be of interest.10

Surgical Care

Surgery often is necessary for repair of late lymphogranuloma venereum (LGV) complications such as fistulas and strictures.

Consultations

Surgical consultation for lymphadenopathy is generally not required unless extensive buboes require further exploration. For tertiary disease, appropriate surgical consultation is indicated.

A clinical guideline summary from the US Preventive Services Task Force, Behavioral counseling to prevent sexually transmitted infections: U.S. Preventive Services Task Force recommendation statement, may be helpful.11

Medication

The goal of pharmacotherapy for lymphogranuloma venereum (LGV) is to reduce morbidity and to prevent complications.

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.


Doxycycline (Doryx, Bio-Tab)

Inhibits protein synthesis in bacteria by binding to the 30S and possibly the 50S ribosomal subunits.

Adult

100 mg PO bid for 21 d (full course)

Pediatric

<8 years: Not recommended
>8 years: 4.4 mg/kg PO qd or divided bid on day 1 then 2.2-4.4 mg/kg/d PO qd or divided bid; not to exceed 200 mg/d

Antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate can decrease bioavailability; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; monitor prothrombin activity in patients taking both medications concurrently; coadministration of tetracyclines can decrease pharmacologic effectiveness of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Use in last half of pregnancy and in children <8 y may cause permanent dental discoloration; in conjunction with prolonged exposure to sunlight or tanning equipment, can cause photosensitivity reaction; lower dosing in patients with renal impairment and, if therapy is prolonged, consider drug serum level determinations; never administer outdated tetracyclines because degradation products of tetracyclines are highly nephrotoxic and can cause Fanconilike syndrome


Erythromycin base (Erythrocin)

Inhibits RNA-dependent protein synthesis, possibly by stimulating the dissociation of peptidyl t-RNA from ribosomes. This inhibits bacterial growth (ie, erythromycin is bacteriostatic, not bacteriocidal). In children, consider age, weight, and severity of infection to determine proper dosage. When bid dosing is desired, half total daily dose may be taken q12h. For more severe infections, dose may be doubled.

Adult

500 mg PO qid for 21 d

Pediatric

30-50 mg/kg/d PO divided q6-8h

Theophylline, digoxin, carbamazepine, and cyclosporine toxicity may increase when administered concurrently; may potentiate anticoagulant effects of warfarin
May significantly alter metabolism of nonsedating antihistamines and cause serious adverse cardiovascular events; concurrent use of lovastatin and erythromycin may cause rhabdomyolysis in patients who are seriously ill; may increase serum theophylline levels and toxicity; concomitant administration of digoxin may result in elevated serum digoxin levels; coadministration can increase effects of anticoagulants; concurrent use with ergotamine or dihydroergotamine has been associated with acute ergot toxicity; erythromycin may decrease clearance of triazolam and midazolam; erythromycin in patients taking other drugs metabolized by cytochrome P-450 system may be associated with elevations in serum concentrations of those drugs; has demonstrated QTc prolongation in combination with other drugs that prolong the QT interval

Documented hypersensitivity; hepatic impairment

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate preparation may cause cholestatic jaundice; GI adverse effects are common; therefore, administer after meals; discontinue if nausea, vomiting, malaise, abdominal colic, and/or fever occur

More on Lymphogranuloma Venereum

Overview: Lymphogranuloma Venereum
Differential Diagnoses & Workup: Lymphogranuloma Venereum
Treatment & Medication: Lymphogranuloma Venereum
Follow-up: Lymphogranuloma Venereum
References
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References

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  2. Herida M, de Barbeyrac B, Sednaoui P, et al. Rectal lymphogranuloma venereum surveillance in France 2004-2005. Euro Surveill. Sep 2006;11(9):155-6. [Medline].

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  5. van de Laar MJ. The emergence of LGV in western Europe: what do we know, what can we do?. Euro Surveill. Sep 2006;11(9):146-8. [Medline].

  6. Chen CY, Chi KH, Alexander S, et al. The molecular diagnosis of lymphogranuloma venereum: evaluation of a real-time multiplex polymerase chain reaction test using rectal and urethral specimens. Sex Transm Dis. Jul 2007;34(7):451-5. [Medline].

  7. Hadfield TL, Lamy Y, Wear DJ. Demonstration of Chlamydia trachomatis in inguinal lymphadenitis of lymphogranuloma venereum: a light microscopy, electron microscopy and polymerase chain reaction study. Mod Pathol. Dec 1995;8(9):924-9. [Medline].

  8. Klotz SA, Drutz DJ, Tam MR, Reed KH. Hemorrhagic proctitis due to lymphogranuloma venereum serogroup L2. Diagnosis by fluorescent monoclonal antibody. N Engl J Med. Jun 30 1983;308(26):1563-5. [Medline].

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Further Reading

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Keywords

lymphogranuloma venereum, LGV, Chlamydia trachomatis, C trachomatis, STD, sexually transmitted chlamydial disease, sexually transmitted disease, chlamydia

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Contributor Information and Disclosures

Author

Jose Antonio Plaza, MD, Director of Dermatopathology, Department of Pathology, Froedtert Hospital; Assistant Professor, Department of Pathology, Section of Dermatopathology, Medical College of Wisconsin
Jose Antonio Plaza, MD is a member of the following medical societies: American Medical Association and American Society for Clinical Pathology
Disclosure: Nothing to disclose.

Coauthor(s)

Victor G Prieto, MD, PhD, Director of Dermatopathology, Professor, Departments of Pathology and Dermatology, University of Texas MD Anderson Cancer Center
Victor G Prieto, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Medical Association, American Society for Clinical Pathology, American Society of Dermatopathology, College of American Pathologists, European Society of Pathology, International Society of Dermatopathology, Society for Investigative Dermatology, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Medical Editor

Terry L Barrett, MD, Clinical Professor of Dermatology and Pathology, University of Texas Southwestern School of Medicine; Director, ProPath Dermatopathology, Dallas, Texas
Terry L Barrett, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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